The rationale for isolation of the left atrial pulmonary venous component to control atrial fibrillation: A review article

Elbatran, Ahmed I; Anderson, Robert H.; Mori, Shigeo; Saba, Magdi

doi:10.1016/j.hrthm.2019.03.012

Cited by 34 publications

(42 citation statements)

References 46 publications

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“…PV‐Comp was defined as the four pulmonary veins and the intervening region of the left atrial wall . Persistent AF was defined as AF that lasted longer than 7 days.…”

Section: Methodsmentioning

confidence: 99%

“…In an anatomical sense, the pulmonary venous component (PV‐Comp) of the left atrium constitutes the dome, or superior aspect, of the left atrium, whereas the true left atrial posterior wall extends from the level of the lower border of the inferior pulmonary veins to the vestibule. We will therefore refer to the pulmonary veins, their antra, and the intervening atrial wall as the PV‐Comp …”

Section: Introductionmentioning

confidence: 99%

“…While isolating the entire PV‐Comp is mechanistically promising for the control of persistent AF, previous studies have provided conflicting results. This study adds to the literature examining the effect of PV‐Comp isolation in persistent AF, in terms of recurrence of tachyarrhythmia and procedural complications.…”

Section: Introductionmentioning

confidence: 99%

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Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis

Elbatran

Gallagher

et al. 2019

Pacing Clinical Electrophis

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Background: The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV-Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV-Comp isolation is an alternative strategy for persistent AF ablation. Methods: Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n = 100; PV-Comp isolation, n = 100) were selected by propensity score matching. Both groups were followed up for 1 year. Results: At 6-and 12-month follow-up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P = .006) and 33 patients (P < .001) in PV-Comp isolation group, respectively. PV-Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV-Comp isolation: 10 months, log-rank P < .001) and a lower probability of recurrence (odds ratio [OR] = 0.32; 95% confidence of interval [CI] = 0.18-0.56, P < .001), with no increase in procedural complications (PVI: 5 of 100, PV-Comp isolation: 6 of 100, P = .76). Procedure duration was longer in PV-Comp isolation group (PVI: 186 ± 42 min, PV-Comp isolation: 238 ± 44 min, P < .001), as well as fluoroscopy time (PVI: 22 ± 16 min, PV-Comp isolation: 31 ± 21 min, P = .001). Conclusion: PV-Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications. K E Y W O R D S catheter ablation, persistent atrial fibrillation, posterior wall isolation, pulmonary vein isolation, pulmonary venous component

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“…PV‐Comp was defined as the four pulmonary veins and the intervening region of the left atrial wall . Persistent AF was defined as AF that lasted longer than 7 days.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis

Elbatran

Gallagher

et al. 2019

Pacing Clinical Electrophis

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“…Pulmonary vein antral isolation (PVAI) remains the backbone of contemporary atrial fibrillation (AF) ablation 3 ; however, given limited efficacy as a standalone approach for PeAF, numerous other lesion sets have been proposed including ablation of nonpulmonary vein triggers, left atrial appendage, coronary sinus and superior vena cava isolation, ablation of focal rotors/drivers, low voltage/scar ablation, and posterior wall isolation (PWI) 4‐7 . Given a shared embryologic origin with the pulmonary veins, the posterior wall, in particular, has garnered significant interest as a target in PeAF ablation 8 . A large body of literature has reported outcomes of PWI as an adjunct to PVAI.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of convergent atrial fibrillation ablation with continuous rhythm monitoring

Larson

Merchant

Patel

et al. 2020

Cardiovasc electrophysiol

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Background: Outcomes of catheter ablation for persistent atrial fibrillation (PeAF) are suboptimal. The convergent procedure (CP) may offer improved efficacy by combining endocardial and epicardial ablation. Methods:We reviewed 113 consecutive patients undergoing the CP at our institution. The cohort was divided into two groups based on the presence (n = 92) or absence (n = 21) of continuous rhythm monitoring (CM) following the CP. Outcomes were reported in two ways. First, using a conventional definition of any atrial fibrillation/atrial tachycardia (AF/AT) recurrence lasting >30 seconds, after a 90 day blanking period. Second, by determining AF/AT burden at relevant time points in the group with CM.Results: Across the entire cohort, 88% had either persistent or long-standing persistent AF, mean duration of AF diagnosis before the CP was 5.1 ± 4.6 years, 45% had undergone at least one prior AF ablation, 31% had impaired left ventricle ejection fraction and 62% met criteria for moderate or severe left atrial enlargement. Mean duration of follow-up after the CP was 501 ± 355 days. In the entire cohort, survival free from any AF/AT episode >30 seconds at 12 months after the blanking period was 53%. However, among those in the CM group who experienced recurrences, mean burden of AF/AT was generally very low (<5%) and remained stable over the duration of follow-up. Ten patients (9%) required elective cardioversion outside the 90 day blanking period, 11 patients (9.7%) underwent repeat ablation at a mean of 229 ± 178 days post-CP and 64% were off AADs at the last follow-up. Procedural complications decreased significantly following the transition from transdiaphragmatic to sub-xiphoid surgical access: 23% versus 3.8% (P = .005)Conclusions: In a large, consecutive series of patients with predominantly PeAF, the CP was capable of reducing AF burden to very low levels (generally <5%), which appeared durable over time. Complication rates associated with the CP decreased significantly with the transition from transdiaphragmatic to sub-xiphoid surgical

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“…Due to the severe limitations and low effectiveness of antiarrhythmic drug therapy in preventing AF recurrences, invasive methods including catheter ablation has gained widespread use in abolishing AF 5 . In the last 20 years, catheter‐based ablation techniques have proved more successful in achieving rhythm control in AF patients 6 …”

Section: Introductionmentioning

confidence: 99%

General anesthesia is not superior to sedation in clinical outcome and cost‐effectiveness for ablation of persistent atrial fibrillation

Wang

Jia

Shi

et al. 2020

Clinical Cardiology

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Background The strategy of anesthesia used during ablation of atrial fibrillation (AF) remains controversial. This study aimed to compare sedation with general anesthesia (GA) for catheter ablation of AF. Hypothesis The presence of AF is associated with an increased risk of stroke and heart failure and decreased quality of life and survival. Methods We carried out a retrospective single‐centered study with 351 patients undergoing the first ablation procedure for AF under sedation or GA. The main outcome was freedom from recurrence of AF at 1 year. The total time of staying at the ablation laboratory and procedure cost were also calculated. Results Freedom from atrial arrhythmia and ablation time did not differ between AF patients under sedation and GA (77.9% vs 79.9% and 42.27 ± 9.84 minutes vs 41.51 ± 9.27 minutes, respectively), while the total procedure time and cost were lower in patients who underwent sedation than GA (171.39 ± 45.09 minutes vs 202.92 ± 43.85 and 8.00 ± 7.02 CNY vs 8.79 ± 11.63 CNY, respectively). Conclusion GA is not superior to sedation, in terms of ablation time and freedom from atrial arrhythmia at 1 year, whereas patients with GA had more anesthesia time and procedure cost than sedation.

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The rationale for isolation of the left atrial pulmonary venous component to control atrial fibrillation: A review article

Abstract: The rationale for isolation of the left atrial pulmonary venous component to control atrial fibrillation: a review article

Cited by 34 publications

References 46 publications

Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis

Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis

Outcomes of convergent atrial fibrillation ablation with continuous rhythm monitoring

General anesthesia is not superior to sedation in clinical outcome and cost‐effectiveness for ablation of persistent atrial fibrillation

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